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DSH190054B IBERIA MEDICAL CENTER (Active)
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Main Details
Name
IBERIA MEDICAL CENTER
Subdivision Name
IBERIA MEDICAL CENTER NORTH CAMPUS / Outpatient Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190054B
Medicare Provider Number
190054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/24/2017
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Iberia Medical Center
Amy Langlinais, CFO
(337) 374-7104
Primary Contact
Iberia Medical Center
Brennon LeBlanc, Director of Cancer Services
(337) 374-7554
Addresses
Street Address
600 NORTH LEWIS STREET
NEW IBERIA, LA 70563-2043
Billing Address
IBERIA MEDICAL CENTER
2315 East Main Street
New Iberia, LA 70560
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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